Victory for Women
2011 Academic Scholarship for Women with Bleeding Disorders
The National Hemophilia Foundation is pleased to offer the Victory for Women Academic
Scholarship for Women with Bleeding Disorders. This scholarship is designed to benefit
women with bleeding disorders in their pursuit of post-high school studies. The scholarship is
inspired by the generosity of two extraordinary young women in the bleeding disorders
community: Josephine Droney and Lindsey Hanson.
About Victory for Women
Victory for Women (V4W) is NHF’s women’s health and blood disorders initiative. The major
goals of V4W are to raise awareness outside of the bleeding disorders community, and support
the development of educational resources and programs for women with bleeding disorders.
2011 Guidelines
Two awards of $2,500 each will be granted. These funds may be used to pay expenses related to
undergraduate or graduate studies at a college, university or an accredited vocational school.
Who Can Apply?
Applicants must be female residents of the US and have a bleeding disorder diagnosed by a
hematologist.*
*Note: this includes those with a diagnosis of von Willebrand disease, hemophilia or other
clotting factor deficiency, or carrier status.
Application Requirements
Please complete the requirements below.
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Application Form
Essay
School Reference
Chapter/Association Reference
Eligibility and Selection Process
Applications will be evaluated by a review committee. Scholarships will be awarded based on a
complete application, essay, achievements and community service to the bleeding disorders
community. The winners will be announced during the last week of June 2011.
Winners are required to participate in one project during the year of their scholarship in
collaboration with the V4W program. This will be planned after the award is announced, and will
not interfere with the recipient’s educational or personal commitments.
Deadline
All applications must be postmarked by Friday, May 20, 2011. Please complete the application
and references, and either mail it or scan and e-mail to:
Patrice Flax
V4WAcademic Scholarship
P.O. Box 971483
Ypsilanti, MI 48197
pflax@hemophilia.org
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Victory for Women Academic Scholarship
APPLICATION
Please print or type the following information. This form along with your essay and a statement of
recommendation must be postmarked no later than Friday, May 20, 2011. Please mail to: Patrice Flax, V4W
Academic Scholarship, P.O. Box 971483, Ypsilanti, MI 48197
Name of applicant
Age
Home address _______________________________________________________________
____________________________________________________________________________
Home telephone (
)_________________
E-mail_________________________________________________________________________
Best time to contact __________________________________________A.M./P.M.
Bleeding disorder diagnosis
________________________________________________________________________________
________________________________________________________________________________
My local chapter/association is ___________________________________________
My hemophilia treatment center or hematologist is ________________________________________
Current school
Current GPA ________________________
School you will attend in the fall ___________________________________________________________
Address
_____________________________________________________________________
Please complete if applicant is younger than 18 years old.
Name of parent/guardian
Signature
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Victory for Women Academic Scholarship
APPLICATION (Continued)
Please list all activities that you have been involved in for the last four years. Please include dates if possible.
You may use additional pages if necessary.
SCHOOL ORGANIZATIONS
ATHLETICS
AWARDS, HONORS, ACHIEVEMENTS
VOLUNTEER WORK/COMMUNITY SERVICE (Please also include work pertaining to bleeding disorders)
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Victory for Women Academic Scholarship
ESSAY
Please respond to the following essay question in 250 words or less. Please print or type.
You may use the space below or a separate sheet of paper. Must be postmarked by Friday,
May 20, 2011.
Please describe how your education and future career plans will benefit others in the
bleeding disorders community.
(The essay and the applicant’s volunteer activities on behalf of the bleeding disorders
community are the key factors determining the award.)
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Victory for Women Academic Scholarship
SCHOOL REFERENCE
Note to applicant: Please give this form to a reference at school (e.g., a teacher, coach, extracurricular activity
advisor, or guidance counselor) who can answer the following questions. Relatives are discouraged. Please
mail to: Patrice Flax, P.O. Box 971483, Ypsilanti, MI 48197. Must be postmarked by Friday, May 20,
2011.
Name of applicant:
Address of applicant:
Name and address of school ________________________________________________________________
_______________________________________________________________________________________
What is your relationship to the above applicant?
Name and address of reference:
Phone number/e-mail address of reference:
How long have you been acquainted with this applicant?
What are this applicant’s most significant talents?
Please describe in detail why you are recommending this person for the Victory for Women Academic
Scholarship. (You may attach a separate page if you choose.)
Signature of reference
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Victory for Women Academic Scholarship
CHAPTER/ASSOCIATION/HTC REFERENCE
Note to applicant: Please give this form to a person whom you have worked with at a chapter, local
association, or hemophilia treatment center (HTC). Please print or type the following information. Note: you
may attach a separate page if you choose. Please mail to: Patrice Flax, P.O. Box 971483, Ypsilanti, MI.
48197. Must be postmarked by Friday, May 20, 2011.
Name of applicant:
Please describe in detail why you are recommending this person for the Victory for Women Academic
Scholarship.
Please list the candidate’s responsibilities and accomplishments while volunteering within your organization.
Signature of reference
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